Abstract Body: The effects of renal percutaneous transluminal angioplasty (rPTA) of renal artery stenosis (RAS) on BP and renal function are controversial. We aim to search for possible differences in these outcomes in different clinical settings.
We conducted an observational analysis of effects of rPTA in patients with RAS diagnosed as a result of: screening patients with peripheral artery disease (Vascular Dpt.; G1, n = 20), patients with resistant hypertension or with clinical suspicion of RAS (Hypertension Unit; G2, n = 28) or kidney transplant patients with renal function impairment and/or elevation of BP (Transplantation Unit; G.3, n = 21). RAS is defined as a reduction of ≥70% of the renal artery lumen.
Sixty-nine patients were examined (mean age 67±12yr, 64% male). Overall, mean±S.D. baseline SBP/DBP (mmHg) was 147.4±20.6 and 75.7±1.8, and the estimated glomerular filtration rate (eGFR) was 48.7±27.0 mL/min/1.73m². G.1 exhibited a higher prevalence of smoking patients (90%) and patients with past major vascular events (100%), lower DBP (70.0±9.8 mmHg) and better renal function (eGFR: 62.5±23.2 mL/min/1.73m²), compared to G.2 and G.3.
Twelve months after rPTA, BP decreased only in patients in G.2 and G.3: variation of (Δ) SBP(mmHg): mean (95%CI)= -18.9 (-26.7 to -11.0) and -20.0 (-29.8 to -10.1), respectively; p<0.001 for both; ΔDBP (mmHg): mean (95%CI)= -6.6 (-10.7 to -2.4), p=0.003 and -6.3 (-11.7 to -0.8), p=0.027, respectively. Regarding renal function, it only improved in G.3: ΔeGFR (mL/min/1.73m²): mean (95%CI)= 8.9 (1.5 to 16.4), p=0.022. ΔSBP was associated with baseline SBP (r= -0.709, p<0.001) and the origin group (Rho = -0.362, p = 0.003); ΔeGFR was associated with baseline eGFR (r= -0.508, p<0.001) and the origin group (Rho = 0.356, p = 0.004). Overall, median ΔSBP was -11 mmHg, and median ΔeGFR was +1.0 mL/min/1.73m². An ANOVA analyzed factors associated with these changes. After adjusting for confounders, ΔSBP was dependent on baseline SBP and group of origin (both p<0.05; adjusted R² 0.340). ΔeGFR was dependent on baseline eGFR and diabetes (both p<0.05; adjusted R² 0.123).
Blood pressure decreased in patients with suspected RAS because of resistant hypertension 12 months after rPTA. Both BP and renal function improved after rPTA in kidney transplant patients with diagnosis of RAS. Higher BP levels and lower eGFR correlated with better results. Patients with peripheral artery disease screened for RAS showed no change in BP or renal function after rPTA.